Pressure resistant conductive fluid containment

ABSTRACT

A conductive fluid reservoir can be used to dispense conductive fluid to increase electrical connectivity between an electrode of a defibrillator and a patient. The reservoir includes a container that holds the conductive fluid, one or more outlets on the container, and an inflatable pouch located at least partially within the container. The inflatable pouch is capable of being inflated from a deflated state to an inflated state. In the deflated state, a free end of the inflatable pouch covers the one or more outlets. In the inflated state, the free end of the inflatable pouch is removed from the one or more outlets such that the conductive fluid is allowed to flow out of the container via the one or more outlets. Inflating the inflatable pouch causes the conductive fluid to be dispensed from the reservoir.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.15/213,247 filed on Jul. 18, 2016, which in turn is a continuation ofU.S. patent application Ser. No. 14/523,488, filed Oct. 24, 2014, andsince issued as U.S. Pat. No. 9,393,437 B2 on Jul. 19, 2016, which inturn claims the benefit of U.S. Provisional Patent Application No.61/974,070, filed Apr. 2, 2014, the contents of which are herebyincorporated by reference in their entirety.

BACKGROUND

External defibrillators are electronic devices that can be used toautomatically diagnose and treat patients with particular cardiacproblems. External defibrillators typically treat patients throughdefibrillation, which is a process that delivers an electrical dischargeto a patient's heart to stop cardiac arrhythmias. The defibrillation canallow the patient's heart to reestablish an effective rhythm.

Many cardiac conditions that are treatable by external defibrillatorscan lead to death or serious injury (e.g., brain damage) within minutesof the onset of symptoms if defibrillation is not delivered to thepatient. The patient's chances for avoiding death or permanent injuryincrease as the time between the onset of symptoms and defibrillationtreatment decreases. In some cases, the survival rate of patientssuffering from cardiac arrhythmia decreases by about 10% for each minutethe administration of treatment is delayed, and the survival rate ofsome patients can be less than 2% after about 10 minutes withouttreatment.

Some patients have medical conditions that make the patients especiallysusceptible to needing defibrillation treatment. For example, patientsthat have recently suffered a heart attack or undergone a heartprocedure, such as bypass surgery, may have a higher risk for alife-threatening arrhythmia. Those patients may benefit from the use ofa wearable defibrillator. A wearable defibrillator includes a garmentthat can be worn beneath the patient's clothing. The wearabledefibrillator also includes a monitor-defibrillator that constantlymonitors the patient's heart for life-threatening heart rhythms andautomatically delivers defibrillation treatment to the patient's heartif a life-threatening heart rhythm is detected.

In order to take most advantage of a wearable defibrillator, thecomponents of a wearable defibrillator need to be effective for the timethat the patient wears the wearable defibrillator. Making a wearabledefibrillator comfortable for the patient to wear and usable for thelength of time that the patient wears the wearable defibrillatorincreases the likelihood that the patient will be wearing the wearabledefibrillator when an arrhythmia develops and that the patient willreceive effective treatment for the arrhythmia.

SUMMARY

The following summary is provided to introduce a selection of conceptsin a simplified form that are further described below in the DetailedDescription. This summary is not intended to identify key features ofthe claimed subject matter, nor is it intended to be used as an aid indetermining the scope of the claimed subject matter.

In at least one embodiment, a system for use with a wearabledefibrillator worn by a patient includes an electrode, a source ofpressurized fluid (e.g., a pressurized liquid or a pressurized gas), aconductive fluid reservoir, and a controller. The conductive fluidreservoir contains a conductive fluid. The conductive fluid reservoirincludes one or more outlets and an inflatable pouch. The controller isconfigured to control selective delivery of pressurized fluid from thesource of pressurized fluid to the inflatable pouch. The inflatablepouch is configured to be inflated from a deflated state to an inflatedstate in response to pressurized fluid being delivered from the sourceof pressurized fluid. In the deflated state, a free end of theinflatable pouch covers the one or more outlets. In the inflated state,the free end of the inflatable pouch is removed from the one or moreoutlets such that the conductive fluid is allowed to flow from theconductive fluid reservoir through the one or more outlets to increaseelectrical connectivity between the electrode and the patient.

In one example, the conductive fluid reservoir is one of a plurality ofconductive fluid reservoirs. The source of pressurized fluid can becoupled to each of the plurality of conductive fluid reservoirs viafluid channels. In another example, the system includes a monitorconfigured to monitor a heart rhythm of the patient. The controller canbe configured to cause pressurized fluid to be delivered from the sourceof pressurized fluid to the inflatable pouch in response to the monitordetecting an arrhythmia while monitoring the heart rhythm of thepatient. In another example, the system includes a defibrillatorconfigured to deliver an electrical discharge to the patient via theelectrode and the conductive fluid. In another example, the source ofpressurized fluid comprises a gas generator. In yet another example, thesystem also includes a second electrode, a second source of pressurizedfluid, and a second conductive fluid reservoir comprising an inflatablepouch, where the controller is configured to control selective deliveryof pressurized fluid from the second source of pressurized fluid to theinflatable pouch of the second conductive fluid reservoir.

In another embodiment, a conductive fluid reservoir includes a containerconfigured to hold a conductive fluid, one or more outlets on thecontainer, and an inflatable pouch located at least partially within thecontainer. The inflatable pouch is capable of being inflated from adeflated state to an inflated state. In the deflated state, a free endof the inflatable pouch covers the one or more outlets. In the inflatedstate, the free end of the inflatable pouch is removed from the one ormore outlets such that the conductive fluid is allowed to flow out ofthe container via the one or more outlets.

In at least one example, the conductive fluid reservoir includes a sealbetween the inflatable pouch and the one or more outlets when theinflatable pouch is in the deflated state. The seal between theinflatable pouch and the one or more outlets is broken when theinflatable pouch is inflated from the deflated state to the inflatedstate. In another example, the inflatable pouch has a U-shape thatincludes a first side and a second side. The free end of the inflatablepouch can cover the one or more outlets on the first side of theU-shape. In another example, the inflatable pouch has a ring shape. Inanother example, the inflatable pouch includes an inlet that protrudesoutside of the container, and the inlet is configured to receivepressurized fluid from a source of pressurized fluid. In yet anotherexample, the free end of the inflatable pouch has a saw-tooth shape thatincludes peaks and valleys, and at least one of the valleys is locatednear the one or more outlets.

In another embodiment, a method of preparing a patient fordefibrillation treatment includes monitoring a heart rhythm of a patientby a monitor, detecting an arrhythmia by the monitor while monitoringthe heart rhythm of the patient, and dispensing conductive fluid from areservoir in response to the monitor detecting the arrhythmia.Dispensing the conductive fluid includes causing pressurized fluid toinflate an inflatable pouch in the reservoir from a deflated state to aninflated state. Inflation of the inflatable pouch from the deflatedstate to the inflated state causes a free end of the inflatable pouch tobe removed from one or more outlets in the reservoir to permit theconductive fluid to flow out of the reservoir via the one or moreoutlets.

In at least one example, the method further includes delivering, by adefibrillator, an electric charge to the patient via the first electrodeand the conductive fluid. In another example, the monitoring includesmonitoring the heart rhythm of the patient using a second electrode thatis different from the first electrode. In yet another example, causingthe pressurized fluid to inflate the inflatable pouch includes one ormore of causing a gas generator to generate the pressurized fluid oropening a valve between a source of pressurized fluid and the inflatablepouch.

DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts a diagram of a defibrillation scene.

FIG. 2 depicts a table listing two main types of externaldefibrillators.

FIG. 3 depicts a diagram showing components of an example of an externaldefibrillator.

FIG. 4 depicts an embodiment of components of a wearable defibrillatorsystem.

FIGS. 5A to 5C depict cross-sectional views of an embodiment of atraditional conductive fluid reservoir.

FIG. 5D depicts an exploded view of a system for use in dispensingconductive fluid from one or more reservoirs to increase electricalconnectivity between a patient's skin and an electrode.

FIGS. 6A to 6E depict various views of an embodiment of a reservoir withan inflatable pouch that addresses drawbacks in the reservoir describedin FIGS. 5A to 5C.

FIGS. 7A to 7C depict another embodiment of a reservoir with anotherembodiment of an inflatable pouch.

FIGS. 8A to 8C depict another embodiment of a reservoir with anotherarrangement of outlets and another embodiment of an inflatable pouch.

FIG. 9 depicts an embodiment of a free end of an inflatable pouch thatcan be used with any of the embodiments of inflatable pouches describedherein.

FIG. 10 depicts an embodiment of a system that can be used with any ofthe conductive fluid reservoirs described herein.

FIG. 11 depicts an embodiment of a method for using any of theconductive fluid reservoirs described herein.

FIGS. 12A and 12B depict an embodiment of a conductive fluid reservoirthat includes a pressurized balloon and a release valve.

FIGS. 13A and 13B depict an embodiment of a conductive fluid reservoirthat includes a pressurized balloon that can be punctured using apuncturing device.

DETAILED DESCRIPTION

Wearable defibrillators have electrode pads that can be placed on apatient's skin and deliver an electrical discharge through the patient'sskin to the patient's heart. To improve delivery of the electricaldischarge through the patient's skin, a conductive fluid (e.g., anelectrolyte gel) can be dispensed to increase electrical connectivitybetween the electrode pads and the patient's skin. Electrolyte gels aretypically water-based solutions that include salts (e.g., electrolytes)for electrical conductivity. With non-wearable defibrillators, such aswith an automated external defibrillator (AED), an electrode pad caninclude an adhesive gel that both adheres the electrical pad to thepatient's skin and improves electrical connectivity between theelectrode pad and the patient's skin.

However, adhesive gel electrode pads are not ideal for use with wearabledefibrillators. Over time, the adhesive properties of an adhesive gelelectrode pad can deteriorate as the patient wears the electrode pad.The deteriorating adhesive properties of the adhesive gel electrode padcan cause the electrode pad to peel off of the patient's skin, renderingthe electrode pad unusable since the electrode pad is no longer properlyadhered to the patient. In addition, after the adhesive gel electrodepad had been removed once, the adhesive gel electrode pad will notadhere to the patient's skin as effectively a subsequent time. Thecontact of an adhesive gel electrode pad to a patient's skin can alsocause skin irritation and discomfort over time. Thus, adhesive gelelectrode pads are not ideal for wearable defibrillators that are wornby patients over longer periods of time.

Instead of applying a conductive fluid between an electrode and thepatient's skin when the patient begins wearing a wearable defibrillator,a conductive fluid can be stored in a reservoir and dispensed toincrease electrical connectivity between an electrode of the wearabledefibrillator and the patient's skin as needed when the wearabledefibrillator prepares to deliver an electrical discharge to thepatient. In some wearable defibrillators, the garment portion of thewearable defibrillator includes a conductive material that is positionedbetween an electrode and the patient's skin. Before the electrode willbe used to deliver an electrical discharge to the patient's heart, aconductive fluid can be dispensed to increase electrical connectivityfrom the electrode through the conductive material to the patient'sskin. The conductive fluid can be stored in one or more fluid reservoirsand then be automatically dispensed from the fluid reservoirs by thewearable defibrillator before the wearable defibrillator delivers anelectrical discharge to the patient's heart.

Depicted in FIG. 1 is a diagram of a defibrillation scene. A patient 82is experiencing a condition in his or her heart 85, which could be, forexample, ventricular fibrillation (VF). An external defibrillator 100has at least two defibrillation electrode pads 104, 108. The electrodepads 104, 108 are coupled to the external defibrillator 100 viarespective electrode leads 105, 109. The electrode pads 104, 108 areadhered to the skin of the patient 82. The defibrillator 100 canadminister, via the electrode leads 105, 109 and the electrode pads 104,108, a brief, strong electric discharge 111 through the body of thepatient 82. The discharge 111, also known as a defibrillation shock,goes through the patient's heart 85, in an attempt to restart it, forsaving the life of the patient 82.

The defibrillator 100 can be one of many different types ofdefibrillators, each with different sets of features and capabilities.The set of capabilities of the defibrillator 100 is determined byplanning who is likely to use it and what training they would likelyhave. Examples are now described.

FIG. 2 is a table listing two main types of external defibrillators andwho they are primarily intended to be used by. A first type ofdefibrillator 100 is generally called a defibrillator-monitor, becauseit is typically formed as a single unit in combination with a patientmonitor. A defibrillator-monitor is also sometimes called amonitor-defibrillator. A defibrillator-monitor is generally intended tobe used by persons in the medical professions, such as doctors, nurses,paramedics, emergency medical technicians, etc. Such adefibrillator-monitor is intended to be used in a pre-hospital orhospital scenario. In the case of a wearable defibrillator-monitor, amedical professional can fit the wearable defibrillator-monitor on thepatient and/or instruct the patient how to wear the wearabledefibrillator-monitor such that the patient can have the benefit of thewearable defibrillator-monitor while having the freedom to leave amedical treatment facility.

As a defibrillator, the device 100 can be one of different varieties, oreven versatile enough to be able to switch among different modes thatindividually correspond to the different varieties. One variety is thatof an automated defibrillator that can determine whether treatment byway of an electrical discharge is needed and, if so, charge to apredetermined energy level and instruct the user to administer thedischarge.

As a patient monitor, the device 100 has features that are additional towhat is minimally needed for mere operation as a defibrillator. Thesefeatures can be used for monitoring physiological indicators of a personin an emergency scenario. These physiological indicators are typicallymonitored as signals. For example, these signals can include a person'sfull electrocardiogram (ECG) signals, a subset of the ECG signals,and/or an impedance between two electrodes placed on a person.Additionally, the monitored signals can represent the person'stemperature, a noninvasive blood pressure (NIBP), an arterial oxygensaturation through pulse oximetry (SpO2), a concentration or partialpressure of carbon dioxide in the respiratory gases (capnography), andso on. These signals can be further stored and/or transmitted as patientdata.

There are additional types of external defibrillators that are notlisted in the table in FIG. 2. For example, hybrid defibrillators and/orwearable defibrillators are not listed. Hybrid defibrillators can haveaspects of an AED and a defibrillator-monitor. A usual such aspect isadditional ECG monitoring capability.

FIG. 3 is a diagram showing components of an external defibrillator 300made according to embodiments of the present disclosure. Thesecomponents can be employed, for example, in the external defibrillator100 of FIG. 1. The components of FIG. 3 can be provided in a housing301, which is also known as a casing.

The external defibrillator 300 typically includes a defibrillation port310, such as a socket in housing 301. The defibrillation port 310includes nodes 314, 318. Defibrillation electrode pads 304, 308, whichcan be similar to the electrode pads 104, 108 shown in FIG. 1, can beplugged into the defibrillation port 310 so as to make electricalcontact with nodes 314, 318, respectively. It is also possible that theelectrode pads 304, 308 can be connected continuously to thedefibrillation port 310. Either way, the defibrillation port 310 can beused for providing a discharge of electrical energy that has been storedin the defibrillator 300 to the patient 82 via the electrode pads 304,308, as will be discussed later herein.

If the defibrillator 300 is a defibrillator-monitor, as described withreference to FIG. 2, then it can also have an ECG port 319 in thehousing 301 for plugging in ECG leads 309. The ECG leads 309 are usableto sense an ECG signal, e.g., a 12-lead signal, or an ECG signal from adifferent number of leads. A defibrillator-monitor could have additionalports (not shown) and another component 325. In at least one embodiment,the other component 325 may be structured to filter the ECG signal,e.g., by applying at least one filter to the ECG signal so as to removechest compression artifacts resulting from chest compressions beingdelivered to the patient 82.

The defibrillator 300 may also include a measurement source 320 thatcould be a circuit. The measurement source 320 receives physiologicalsignals from the ECG port 319, and also from other ports, if provided.These physiological signals are sensed and information about thephysiological signals is rendered by measurement source 320 as data orother signals.

If the defibrillator 300 is an AED, it may lack the ECG port 319. Insuch an embodiment however, the measurement source 320 can obtainphysiological signals through the nodes 314, 318 instead, when thedefibrillation electrode pads 304, 308 are attached to the patient 82.In this case, a person's ECG signal can be sensed as a voltagedifference between the electrode pads 304, 308. Additionally, impedancebetween the electrode pads 304, 308 can be sensed for detecting, amongother things, whether the electrode pads 304, 308 have beeninadvertently disconnected from the person.

The defibrillator 300 also includes a processor 330. Processor 330 maybe implemented in any number of ways for causing actions and operationsto be performed. The processor 330 may include, by way of example andnot of limitation, digital and/or analog processors such asmicroprocessors and digital-signal processors (DSPs); controllers suchas microcontrollers; software running in a programmable machine;programmable circuits such as Field Programmable Gate Arrays (FPGAs),Field-Programmable Analog Arrays (FPAAs), Programmable Logic Devices(PLDs), Application Specific Integrated Circuits (ASICs), or anycombination of one or more of these.

The processor 330 can be considered to have a number of modules. Onesuch module can be a detection module 332 configured to sense outputs ofthe measurement source 320. The detection module 332 can include a VFdetector, for example. Thus, the patient's sensed ECG can be used by thedetection module 332 to determine whether the patient is experiencingVF.

Another such module in the processor 330 can be an advice module 334configured to determine and provide advice based on outputs of thedetection module 332. The advice module 334 can include a Shock AdvisoryAlgorithm, implement decision rules, and so on. The advice can be toshock, to not shock, to administer other forms of therapy, and so on. Ifthe advice is to shock, some external defibrillator embodiments merelyreport that to a user 380 and prompt the user 380 to initiate the shock.Other embodiments automatically execute the advice, by administering theshock. If the advice is to administer CPR, the defibrillator 300 mayfurther issue prompts to the user 380, and so on.

The processor 330 can include additional modules, such as module 336that provide other functions. In addition, if one or more othercomponents 325 are indeed provided, the component(s) 325 may be operatedin part by the processor 330.

The defibrillator 300 optionally further includes a memory 338 that canwork together with the processor 330. The memory 338 may be implementedin any number of ways. The memory 338 may include, by way of example andnot of limitation, nonvolatile memories (NVM), read-only memories (ROM),random access memories (RAM), any combination of these, and so on. Thememory 338, if provided, can include programs to be executed by theprocessor 330 or the modules therein. The programs can be operationalfor the inherent needs of the processor 330, and can also includeprotocols and algorithms for modules such as the advice module 334 tomake decisions. In addition, the memory 338 can store prompts for theuser 380, etc. Moreover, the memory 338 can store patient data.

The defibrillator 300 may also include a power source 340. To enableportability of the defibrillator 300, the power source 340 typicallyincludes a battery. Such a battery is typically implemented as a batterypack that can be rechargeable or non-rechargeable. Sometimes, acombination of rechargeable and non-rechargeable battery packs is used.Other embodiments of the power source 340 can include an AC poweroverride, for instances where AC power will be available, and so on. Insome embodiments, the power source 340 is controlled by the processor330.

The defibrillator 300 additionally includes an energy storage module350. The energy storage module 350 is where electrical energy is storedwhen the defibrillator 300 is preparing to administer a shock through asudden discharge of energy. The energy storage module 350 can be chargedfrom power source 340 to hold a desired amount of energy, as controlledby the processor 330. In typical implementations, the energy storagemodule 350 includes one or more capacitors 352 to store and dischargethe energy.

The defibrillator 300 further includes a discharge circuit 355. Thedischarge circuit 355 can be controlled by the processor 330 to permitthe energy stored in the energy storage module 350 to be dischargedthrough the nodes 314, 318 to the defibrillation electrode pads 304,308. The discharge circuit 355 can include one or more switches 357 tocontrol the discharge. The switches 357 can be implemented in a numberof ways, such as by an H-bridge circuit, and so on.

The defibrillator 300 further includes a user interface 370 for the user380. The user 380 can be a rescuer or a patient. The user interface 370can be implemented in any number of ways. For example, the userinterface 370 may include a screen to display what is detected andmeasured, provide visual feedback or prompts to a rescuer to aid theirresuscitation attempts, and so on. The user interface 370 may alsoinclude a speaker to issue voice prompts, and various controls, such aspushbuttons, keyboards, and so on. CPR prompts, for example, can beissued, visually or by sound, to the rescuer to help the user administerCPR to the patient. Examples of CPR-prompting technology are taught inU.S. Pat. Nos. 6,334,070 and 6,356,785. In addition, the dischargecircuit 355 can be controlled by the processor 330.

The defibrillator 300 can optionally include other components. Forexample, a communication module 390 may be provided for communicatingwith other machines or devices. Such communication can be performedwirelessly (e.g., by RF or infrared communication), or via wireconnections. Data can be communicated, such as patient data, incidentinformation, therapy attempted, CPR performance, and so on, to othermachines or devices for further evaluation and/or processing.

FIG. 4 depicts an embodiment of components of a wearable defibrillatorsystem as might be worn by the patient 82 depicted in FIG. 1. Patient 82may also be referred to as person 82 and/or wearer 82 since he or shewears components of the wearable defibrillator system.

In FIG. 4, a generic support structure 470 is shown relative to the bodyof person 82, and thus also relative to his or her heart 85. Structure470 could be a harness, a vest, one or more belts, or a garment as perthe above, and could be implemented in a single component or multiplecomponents, and so on. Structure 470 is wearable by person 82, but themanner of wearing it is not depicted, as structure 470 is depicted onlygenerally in FIG. 4.

A wearable defibrillator system is configured to provide a therapy to apatient by delivering electrical energy to the patient's body in theform of an electric discharge that may be conveyed in one or morepulses. FIG. 4 shows one example of an external defibrillator 400 anddefibrillation electrodes 404, 408 that are coupled to the externaldefibrillator 400 via electrode leads 405. Alternative to the electrodepositioning shown in FIG. 4, the electrodes 404, 408 can be positionedanterior and posterior about the body, substantially parallel to eachother, and superimposing the heart. Defibrillator 400 and defibrillationelectrodes 404, 408 are coupled to support structure 470. As such, allcomponents of defibrillator 400 can therefore be coupled to supportstructure 470. When defibrillation electrodes 404, 408 make goodelectrical contact with the body of person 82, defibrillator 400 canadminister, via electrodes 404, 408, a brief, strong electric discharge411 through the body. Discharge 411, also known as a defibrillationshock or therapy shock, is intended to go through the heart 85 andrestart the heart 85 in an effort to save the life of person 82.Discharge 411 can also be one or more pacing pulses, and so on.

The wearable defibrillator system may optionally include an outsidemonitoring device 480. Device 480 is called an “outside” device becauseit is provided as a standalone device not within the housing ofdefibrillator 400. Device 480 is configured to monitor at least onelocal parameter. A local parameter can be a parameter of patient 82, ora parameter of the wearable defibrillation system, or a parameter of theenvironment, as will he described later herein. Optionally, device 480is physically coupled to support structure 470. In addition, device 480can be communicatively coupled with other components that are coupled tosupport structure 470. Such a component can be a communication module,as will be deemed applicable by a person skilled in the art in view ofthis disclosure.

FIGS. 5A to 5C depict cross-sectional views of an embodiment of atraditional conductive fluid reservoir 500 that is usable in a wearabledefibrillator system as shown in FIG. 4. The reservoir 500 contains aconductive fluid 502 within a flexible container 504. The reservoir 500includes one or more outlets 506 through which the conductive fluid 502can flow. As shown in FIG. 5A, a portion of the flexible container 504can be normally positioned to cover the one or more outlets 506. In thisconfiguration, the flexible container 504 seals the one or more outlets506 to hold the conductive fluid 502 within the reservoir 500.

Some or all of the conductive fluid 502 can be dispensed from thereservoir 500 by inflating an inflatable pocket 508 of the flexiblecontainer 504. As shown in FIG. 5B, as the inflatable pocket 508 isinflated, and an upward force 510 lifts a portion of the flexiblecontainer 504 above the one or more outlets 506. The upward force 510 onthe flexible container 504 lifts the flexible container 504 and uncoversthe one or more outlets 506, allowing the some or all of the conductivefluid 502 to flow out of the reservoir 500 via the one or more outlets506. The inflation of the inflatable pocket 508 also exerts a pressureon the conductive fluid 502 to force the conductive fluid 502 out of theone or more outlets 506.

One drawback to the reservoir 500 is depicted in FIG. 5C. As shown inFIG. 5C, an object 512 (e.g., a person's finger) can apply a force tothe flexible container 504. The force from the object 512 can beinadvertent, such when a user accidentally pushes on the flexiblecontainer 504 or when the patient wearing the wearable defibrillatoraccidentally bumps into an object. The force caused by the object 512 onthe flexible container 504 results in an upward force 514 lifting theflexible container 504 away from the one or more outlets 506. The upwardforce 514 uncovers the flexible container 504 from the one or moreoutlets 506 and allows the some or all of the conductive fluid 502 toflow out of the reservoir 500 via the one or more outlets 506.

If the force 512 is an unintended force, the result is unintendeddispensing of the conductive fluid 502 via the one or more outlets 506.To a patient wearing the wearable defibrillator, the unintendeddispensing of the conductive fluid 502 can cause the patient to thinkthat the wearable defibrillator is defective (e.g., it has a leak). Inaddition, such unintended dispensing of the conductive fluid 502 is atbest an annoyance to the user because of the mess of the dispensedconductive fluid 502, and at worst renders the wearable defibrillatorincapable of effectively applying an electrical charge to the patient'sskin. Some efforts to address this issue have been made by surroundingthe pouch 500 in a rigid container (e.g., a stiff foam); however, suchrigid housings make the wearable defibrillator less comfortable to thepatient and decrease patient compliance in wearing the defibrillator.Moreover, a rigid housing may not permit the electrode to bend along acontour of the patient's skin, reducing the contact area between theelectrode and the patient's skin.

FIG. 5D depicts an exploded view of one example of a system for use indispensing conductive fluid from one or more reservoirs 500 to increaseelectrical connectivity between a patient's skin 520 and an electrode530. FIG. 5D depicts the electrode 530 located between the patient'sskin 520 and a reservoir layer 540. Examples of the electrode 530include the defibrillation electrodes 404, 408 described above withrespect to FIG. 4. The electrode 530 can include a conductive fabric orother conductive material that is configured to help conduct an electricdischarge from a defibrillator. In a case where the electrode 530includes a conductive fabric, the electrode 530 can be sewn into asupport structure (e.g., support structure 470) worn by the patient.

In this example, the reservoir layer 540 includes a number of reservoirs500. The number of reservoirs 500 used in reservoir layer 540 can be anynumber of reservoirs. The number of reservoirs 500 can be selected basedon one or more of an amount of conductive fluid contained in eachreservoir 500, a size of the electrode 530, an absorption rate of theelectrode 530, or any other factor. While the reservoir layer 540depicted in FIG. 5D includes reservoirs 500, any of the other reservoirsdescribed herein can be used in the reservoir layer 540 in place of thereservoirs 500.

As shown in FIG. 5D, the electrode 530 can be positioned between thepatient's skin 520 and the reservoir layer 540. Depending on thematerials used to construct the electrode 530, when conductive fluid isreleased from the reservoirs 500, the conductive fluid can permeate theelectrode 530 up to the point of saturating the electrode 530. Some ofthe conductive fluid that has passed through the electrode layer 530 cancontact the patient's skin 520, thereby increasing electricalconnectivity between the electrode 530 and the patient's skin 520. Theelectrode 530 can optionally include one or more holes 532 that permitpassage of the conductive fluid from one side of the electrode 530 tothe other side of the electrode 530.

FIGS. 6A to 6E depict various views of an embodiment of a reservoir 600that addresses drawbacks in the reservoir 500 described in FIGS. 5A to5C. More specifically, FIGS. 6A and 6B depict perspective and top views,respectively, of the reservoir 600, and FIGS. 6C to 6E depictcross-sectional views of the reservoir 600. The reservoir 600 contains aconductive fluid 602 within a container 604. The container 604 can be aflexible container or, alternatively, a rigid or semi-rigid container.The container 604 includes one or more outlets 606 through which theconductive fluid 602 can flow. In the particular embodiment shown inFIGS. 6A and 6B, the one or more outlets 606 include four outletsarranged linearly. However, other numbers of outlets and arrangement ofoutlets are possible. The reservoir 600 also includes an inflatablepouch 608, at least a portion of which is located inside the container604. The inflatable pouch 608 includes an inlet 610 through which apressurized fluid can be forced to inflate the inflatable pouch 608. Asshown in FIGS. 6A and 6B, the inlet 610 can protrude from the container604.

The inflatable pouch 608 is depicted in a deflated state in FIGS. 6C and6D. The inflatable pouch 608 includes a connected end 612 that isdirectly connected to the container 604 and a free end 614 that is notdirectly connected to the container 604. As shown, when the inflatablepouch 608 is in the deflated state, the free end 614 of the inflatablepouch 608 covers the one or more outlets 606. When the inflatable pouch608 covers the one or more outlets 606, the inflatable pouch 608prevents the conductive fluid 602 from flowing out of the container 604via the one or more outlets 606. In at least one embodiment, theinflatable pouch 608 is sealed to the one or more outlets 606 while inthe deflated state. The seal between the inflatable pouch 608 and theone or more outlets 606 can include one or more of an adhesive, a heatweld, or any other type of seal.

As shown in FIG. 6D, an object 616, such as a person's finger, can presson the container 604 causing a force 618 on the container 604. The force618 causes a pressure 620 in the conductive fluid 602 that is exerted onthe free end 614 of the inflatable pouch 608. Unlike the force from theobject 512 on the flexible container 504 in FIG. 5C, the force 618 fromthe object 616 does not cause the free end 614 of the inflatable pouch608 to be uncovered from the one or more outlets 606. To the contrary,the pressure 620 pushes the free end 614 of the inflatable pouch 608toward the one or more outlets 606. In this way, the force 618 of theobject 616 helps to prevent the conductive fluid 602 from leaking out ofthe reservoir 600.

The inflatable pouch 608 is depicted in an inflated state in FIG. 6E. Totransition the inflatable pouch 608 from the deflated state depicted inFIGS. 6C and 6D to the inflated state depicted in FIG. 6E, pressurizedfluid is forced into the inflatable pouch 608 via the inlet 610. Thepressurized fluid can be introduced into the inlet 610 from a fluidsource, such as a gas generator (e.g., a nitrogen generator) or apressurized fluid container (e.g., a gas cylinder). As the inflatablepouch 608 inflates from the deflated state to the inflated state; theshape of the inflatable pouch 608 transitions from flat to round. Thechange in shape of the inflatable pouch 608 from flat to round breaksthe seal between the free end 614 of the inflatable pouch 608 and theone or more outlets 606 and removes the free end 614 of the inflatablepouch 608 from the one or more outlets 606. Once the free end 614 of theinflatable pouch 608 is removed from the one or more outlets 606, theconductive fluid 602 is allowed to flow out of the container 604 via theone or more outlets 606. In the inflated state, the inflatable pouch 608also occupies more of the volume of the container 604 than theinflatable pouch 608 takes up in the deflated state. By occupying morevolume of the container 604 in the inflated state, the inflatable pouch608 exerts a force on the conductive fluid 602 to push the conductivefluid 602 out of the container 604 via the one or more outlets 606.

In the inflated state, the pressure of the gas in the inflatable pouch608 can be in a particular range, such as a range from about 5 psi toabout 30 psi. The pressure of the gas in the inflatable pouch 608 can beselected based on one or more of a strength of the seal between the freeend 614 of the inflatable pouch 608 and the one or more outlets 606, astrength of the material of the inflatable pouch 608, a strength of thematerial of the container 604, a viscosity of the conductive fluid 602,a size of the one or more outlets 606, and so on.

The reservoir 600 can be positioned with respect to the wearabledefibrillator such that, when the conductive fluid 602 is dispensed fromthe one or more outlets 606, the conductive fluid is directed toward alocation that will increase electrical connectivity between an electrodeand the patient's skin. For example, in the case where the garment ofthe wearable defibrillator includes a conductive fabric between thereservoir and the patient's skin, the one or more outlets 606 can beoriented to dispense the conductive fluid 602 toward the conductivefabric. When the one or more outlets 606 are properly oriented and thepouch 608 is inflated, the conductive fluid 602 is dispensed from thecontainer 604 such that the conductive fluid 602 will increaseelectrical connectivity between the electrode and the patient's skin.

The wearable defibrillator can include a monitor that monitors thepatient's heart rhythms. If the wearable defibrillator determines thatthe patient's heart should be treated with an electrical discharge, thewearable defibrillator can cause pressurized fluid to be delivered froma source of pressurized fluid to the inflatable pouch 608 such that theinflatable pouch 608 inflates and the conductive fluid 602 is dispensedto increase electrical connectivity between the electrode and thepatient's skin. After the conductive fluid 602 has been dispensed, thewearable defibrillator can deliver an electrical discharge to thepatient for treatment.

With the reservoir 600 depicted in FIGS. 6A to 6E, the electrode doesnot need to be housed in a rigid structure to prevent accidentaldispensing of conductive fluid 602 from reservoir 600. Because noadditional rigid structure is needed for the reservoir 600, an electrodewith the reservoir 600 can be made compliant, flexible, thin, and lightweight. This leads to easier wear underneath a patient's clothingwithout visible bulk and with greater comfort to the patient wearing thewearable defibrillator. Such benefits lead to better compliance inpatients wearing the wearable defibrillators. The ability to make theelectrode and reservoir 600 compliant also leads to better contour ofthe electrode along the patient's skin, resulting in better contactbetween the electrode and any contours of the patient's skin.

FIGS. 7A to 7C depict another embodiment of a reservoir 700 with anotherembodiment of an inflatable pouch 708. FIG. 7A depicts a top view of thereservoir 700 and FIGS. 7B and 7C depict cross-sectional view of thereservoir 700. The reservoir 700 contains a conductive fluid 702 withina container 704. The container 704 includes one or more outlets 706through which the conductive fluid 702 can flow. The reservoir 700 alsoincludes the inflatable pouch 708, at least a portion of which islocated inside the container 704.

In the embodiment shown in FIG. 7A, the inflatable pouch 708 has aU-shape where the inflatable pouch 708 is located along the left side ofthe container 704, along the bottom side of the container 704, and alongthe right side of the container 704. The inflatable pouch 708 includesan inlet 710 through which a pressurized fluid can be forced to inflatethe inflatable pouch 708. As shown in FIG. 7A, the inlet 710 canprotrude from the container 704.

The inflatable pouch 708 is depicted in a deflated state and in aninflated state in FIGS. 7B and 7C, respectively. The inflatable pouch708 includes a connected end 712 that is directly connected to thecontainer 704 and a free end 714 that is not directly connected to thecontainer 704. The cross-sectional views of the reservoir 700 in FIGS.7B and 7C include cross-sectional views of the inflatable pouch 708 intwo locations corresponding to the two sides of the U-shape of theinflatable pouch 708.

As shown in FIG. 7B, when the inflatable pouch 708 is in the deflatedstate, the free end 714 of the left side of the inflatable pouch 708covers the one or more outlets 706. When the inflatable pouch 708 coversthe one or more outlets 706, the inflatable pouch 708 prevents theconductive fluid 702 from flowing out of the container 704 via the oneor more outlets 706. The right side of the inflatable pouch 708 islocated near the top of the container 704 to provide a clear path forthe conductive fluid 702 between the left and right sides of theinflatable pouch 708. In other embodiments, the right side of theinflatable pouch 708 can be located in other locations. If an objectexerted a force on the top of the container 704, the left side of theinflatable pouch 708 would not be forced up and off of the one or moreoutlets 706.

The inflatable pouch 708 is depicted in an inflated state in FIG. 7C. Totransition the inflatable pouch 708 from the deflated state depicted inFIG. 7B to the inflated state depicted in FIG. 7C, a pressurized fluidis forced into the inflatable pouch 708 via the inlet 710. The fluid canbe introduced into the inlet 710 from a fluid source, such as a fluidgenerator (e.g., a nitrogen generator) or a pressurized fluid container(e.g., a gas cylinder). As the inflatable pouch 708 is inflated from thedeflated state to the inflated state; the shape of the inflatable pouch708 transitions from flat to round. The change in shape of the left sideof the inflatable pouch 708 from flat to round breaks the seal betweenthe free end 714 of the left side of the inflatable pouch 708 and theone or more outlets 706 and removes the free end 714 of the left side ofthe inflatable pouch 708 from the one or more outlets 706. Once the freeend 714 of the left side of the inflatable pouch 708 is removed from theone or more outlets 706, the conductive fluid 702 is allowed to flow outof the container 704 via the one or more outlets 706.

In the inflated state depicted in FIG. 7C, the inflatable pouch 708occupies more of the volume of the container 704 than the inflatablepouch 708 occupies in the deflated state. The U-shape of the inflatablepouch 708 also occupies more volume of the container 704 than theinflatable pouch 608 occupies in the container 604 depicted in FIG. 6E.By occupying more volume of the container 704 in the inflated state, theinflatable pouch 708 exerts a greater force on the conductive fluid 702to push the conductive fluid 702 out of the container 704 via the one ormore outlets 706. The left and right sides of the inflatable pouch 708are arranged such that, when the inflatable pouch is in the inflatedstate, there is a path for most or all of the conductive fluid 702 toflow to the one or more outlets 706.

FIGS. 8A to 8C depict another embodiment of a reservoir 800 with anotheran arrangement of outlets 806 and another embodiment of an inflatablepouch 808. FIG. 8A depicts a top view of the reservoir 800 and FIGS. 8Band 8C depict cross-sectional view of the reservoir 800. The reservoir800 contains a conductive fluid 802 within a container 804. Thecontainer 804 includes one or more outlets 806 through which theconductive fluid 802 can flow. In the particular embodiment shown inFIG. 8A, the one or more outlets 806 include eight outlets arranged withat least one outlet near each of the left, bottom, right, and top sides.However, other numbers of outlets and arrangement of outlets arepossible. The reservoir 800 also includes the inflatable pouch 808, atleast a portion of which is located inside the container 804.

The container 804 has a ring shape with a central attachment portion816. The central attachment portion can include a hole 818. The hole canpermit air to flow through the center of the container 804, making thecontainer 804 more breathable. The inflatable pouch 808 also has a ringshape. In the particular embodiment depicted in FIG. 8A, the inflatablepouch 808 has a rectangular ring shape where the inflatable pouch 808has sides located along the left, bottom, right, and top sides of thecontainer 804. The inflatable pouch 808 includes an inlet 810 throughwhich pressurized fluid can be forced to inflate the inflatable pouch808. As shown in FIG. 8A, the inlet 810 can protrude out from thecontainer 804.

The inflatable pouch 808 is depicted in a deflated state and in aninflated state in FIGS. 8B and 8C, respectively. The inflatable pouch808 includes a connected end 812 that is directly connected to thecontainer 804 and a free end 814 that is not directly connected to thecontainer 804. The cross-sectional views of the reservoir 800 in FIGS.8B and 8C include cross-sectional views of the inflatable pouch 808 intwo locations corresponding to two sides of the rectangular ring shapeof the inflatable pouch 808.

As shown in FIG. 8B, when the inflatable pouch 808 is in the deflatedstate, the free ends 814 of the inflatable pouch 808 covers the outlets806. When the inflatable pouch 808 covers the outlets 806, theinflatable pouch 808 prevents the conductive fluid 802 from flowing outof the container 804 via the one or more outlets 806. The inflatablepouch 808 is depicted in an inflated state in FIG. 8C. To inflate theinflatable pouch 808 from the deflated state depicted in FIG. 8B to theinflated state depicted in FIG. 8C, a pressurized fluid is forced intothe inflatable pouch 808 via the inlet 810. The fluid can be introducedinto the inlet 810 from a fluid source. As the inflatable pouch 808 isinflated from the deflated state to the inflated state; the shape of theinflatable pouch 808 transitions from flat to round. The change in shapeof the inflatable pouch 808 from flat to round breaks the seal betweenthe free ends 814 of the inflatable pouch 808 and the outlets 806 andremoves the free ends 814 of the inflatable pouch 808 from the outlets806. Once the free ends 814 of the inflatable pouch 808 are removed fromthe one or more outlets 806, the conductive fluid 802 is allowed to flowout of the container 804 via the outlets 806.

One advantage to the reservoir 800 is depicted in FIG. 8C. When theinflatable pouch 808 is in the inflated state, both inflated sides ofthe inflatable pouch 808 cause the bottom of the container 804 to bepulled taught. This increases the likelihood that the sides of theinflatable pouch 808 will peel away from the outlets 806 as theinflatable pouch 808 is inflated, increasing the likelihood that theseal between the sides of the inflatable pouch 808 and the outlets 806will break. Another advantage to the reservoir 800 is that the container804 includes more outlets 806 than other embodiments, and that more ofthe conductive fluid 802 is likely to be dispensed from the reservoirwith a greater the number of outlets 806. Another advantage depicted inFIG. 8C is that the central attachment portion 816 eliminates volume ofthe reservoir 800 that would be located in the center of the reservoir800 if the reservoir 800 did not include the central attachment portion816. Because of this reduced volume, the inflatable pouch 808 takes up agreater portion of the volume of the reservoir 800 in the inflatedstate. Because the inflatable pouch 808 takes up a greater portion ofthe volume of the reservoir 800 in the inflated state, inflation of theinflatable pouch 808 will cause more of the conductive fluid 802 to flowout of the outlets 806 than if the reservoir 800 did not include thecentral attachment portion 816.

FIG. 9 depicts an embodiment of a free end 914 of an inflatable pouch908 that can be used with any of the embodiments of inflatable pouchesdescribed herein. FIG. 9 depicts a reservoir 900 that contains aconductive fluid 902 within a container 904. The container 904 includesoutlets 906. The reservoir 900 also includes the inflatable pouch 908,at least a portion of which is located inside the container 904. In theembodiment shown in FIG. 9, the inflatable pouch 908 has free end 914with a saw-tooth shape. The inflatable pouch 908 includes an inlet 910through which fluid can be forced to inflate the inflatable pouch 908.

The saw-tooth shape of the free end 914 of the inflatable pouch 908includes valleys 924 and peaks 926. Individual valleys 924 are locatednear individual outlets 906 and individual peaks 926 are located betweentwo of the outlets 906. As the inflatable pouch 908 is inflated, theportion of the free end near the valleys 924 is more likely to pull awayfrom the container 904. Thus, the free end 914 of the inflatable pouch908 is more likely to peel away from the outlets 906 when the valleys924 of the free end 914 are located near the outlets 906.

FIG. 10 depicts an embodiment of a system 1000 that can be used with anyof the conductive fluid reservoirs described herein. The system 1000includes a controller 1002 that is communicatively coupled to a firstgas generator 1004 and a second gas generator 1006. While gas generators1004, 1006 generating pressurized gas are shown in this embodiment,alternatively other forms of fluid generators or fluid sources may beused to supply pressurized fluid to pouches disposed within theconductive fluid reservoirs 1008, 1012. The first gas generator 1004 isconfigured to selectively provide a pressurized gas via fluid channels1006 to each of one or more conductive fluid reservoirs 1008 that areassociated with a first electrode (not shown). The second gas generator1006 is configured to selectively provide a pressurized gas via fluidchannels 1010 to each of one or more conductive fluid reservoirs 1012that are associated with a second electrode (not shown). In theembodiment shown in FIG. 10, the conductive fluid reservoirs 1008include three conductive fluid reservoirs and the conductive fluidreservoirs 1012 include three conductive fluid reservoirs. However, theconductive fluid reservoirs 1008 and 1012 can have other numbers ofconductive fluid reservoirs. For example, without limitation, a group offour or five conductive fluid reservoirs can be associated with eachelectrode. Moreover, the conductive fluid reservoirs 1008 and 1012 canhave different numbers of conductive fluid reservoirs, such asconductive fluid reservoirs 1008 having four conductive fluid reservoirsand conductive fluid reservoirs 1012 having five conductive fluidreservoirs.

As noted above, in at least one embodiment, the first gas generator 1004and the conductive fluid reservoirs 1008 are associated with a firstelectrode, and the second gas generator 1006 and the conductive fluidreservoirs 1012 are associated with a second electrode. For example, thefirst electrode, the first gas generator 1004, and the conductive fluidreservoirs 1008 can be part of a first electrode assembly, and thesecond electrode, the second gas generator 1006, and the conductivefluid reservoirs 1012 can be part of a second electrode assembly. Thefirst and second electrodes can be positioned in a wearabledefibrillator to be able to deliver an electric charge to a patient'sheart. The controller 1002 can be a part of or coupled to a monitor(e.g., monitoring device 480 shown in FIG. 4) that monitors the rhythmof the patient's heart.

The monitor can monitor the patient's heart using electrodes on thepatient that are different from the first and second electrodes (e.g.,using monitoring electrodes that do not require a conductive fluid toeffectively monitor the patient's heart rhythm). When the monitordetects an arrhythmia, the controller 1002 can send signals to the firstgas generator 1004 and the second gas generator 1006 indicating thatconductive fluid should be dispensed from the conductive fluidreservoirs 1008 and 1012. In response to receiving the signals from thecontroller 1002, the first gas generator 1004 can deliver pressurizedgas via the fluid channels 1006 to the conductive fluid reservoirs 1008and the second gas generator 1006 can deliver pressurized gas via thefluid channels 1010 to the conductive fluid reservoirs 1012. Thepressurized gas delivered to the conductive fluid reservoirs 1008 and1012 can inflate inflatable pouches within the conductive fluidreservoirs 1008 and 1012 to remove free ends of the inflatable pouchesfrom outlets such that conductive fluid flows out of the conductivefluid reservoirs 1008 and 1012. The conductive fluid from the conductivefluid reservoirs 1008 can be directed to increase electricalconnectivity between the first electrode and the patient's skin, and theconductive fluid from the conductive fluid reservoirs 1012 can bedirected to increase electrical connectivity between the secondelectrode and the patient's skin. Once the conductive fluid flows out ofthe conductive fluid reservoirs 1008 and 1012, the wearabledefibrillator can effectively deliver an electrical discharge to thepatient's heart between the first and second electrodes to treat thearrhythmia.

FIG. 11 depicts an embodiment of a method 1100 for preparing a patientfor defibrillation treatment using any of the conductive fluidreservoirs describe herein. At block 1102, a patient's heart rhythm ismonitored. The patient's heart rhythm can be monitored by a monitor in awearable defibrillator-monitor. The patient's heart rhythm can bemonitored using electrodes that are different from electrodes that willbe used to deliver an electric charge to treat any arrhythmia of thepatient's heart. At block 1104, an arrhythmia of the patient's heart canbe detected. Detecting the arrhythmia can include making a determinationthat the arrhythmia requires delivery of an electric charge to thepatient's heart for treatment of the arrhythmia.

At block 1106, conductive fluid is dispensed from conductive fluidreservoirs to increase electrical connectivity between one or moreelectrodes and the patient's skin. The conductive fluid can be dispensedfrom the conductive fluid reservoirs by causing pressurized fluid toinflate inflatable pouches in the conductive fluid reservoirs such thatfree ends of the inflatable pouches are removed from outlets of theconductive fluid reservoirs and the conductive fluid is permitted toflow out of the conductive fluid reservoirs via the outlets. Thepressurized fluid can be caused to inflate inflatable pouches in theconductive fluid reservoirs by a controller sending a signal to one ormore gas generators that are configured to deliver the pressurized fluidto the conductive fluid reservoirs. The pressurized fluid can bedelivered to inflate inflatable pouches in the conductive fluidreservoirs in other ways, such as by opening a valve between a source ofpressurized fluid and the conductive fluid reservoirs. At block 1108, anelectrical discharge is delivered to the patient's heart via the one ormore electrodes and the dispensed conductive fluid.

FIGS. 12A, 12B, 13A, and 13B depict embodiments of conductive fluidreservoirs in the form of pressurized balloons. The pressurized balloonscan be used to dispense a conductive fluid to increase electricalconnectivity between an electrode and the patient's skin. The conductivefluid can be stored under pressure in the balloon such that, when theballoon is opened, the conductive fluid automatically dispenses out ofthe balloon. The balloon can be located and/or oriented such that theconductive fluid is directed to increase electrical connectivity betweenan electrode and the patient's skin when the balloon is opened.

FIGS. 12A and 12B depict an embodiment of a conductive fluid reservoir1200 that includes a pressurized balloon 1204. The pressurized balloon1204 contains a conductive fluid 1202. The pressurized balloon 1204includes a release valve 1206 that can be selectively opened to allowsome or all of the conductive fluid 1202 out of the pressurized balloon1204. FIG. 12A depicts the release valve 1206 in a closed position andFIG. 12B depicts the release valve 1206 in an open position with theconductive fluid 1202 flowing out of the pressurized balloon 1204.

The release valve 1206 can be controlled by the wearable defibrillatorsuch that the release valve 1206 is opened automatically before thewearable defibrillator delivers an electrical discharge to the patient'sbody. Furthermore, using the release valve 1206 with the pressurizedballoon 1204 may allow the pressurized balloon 1204 to be refilled withadditional conductive fluid and reused. The release valve 1206 can beoriented such that the conductive fluid 1202 is directed to increaseelectrical connectivity between an electrode of the wearabledefibrillator and the patient's skin when the release valve 1206 isopened.

FIGS. 13A and 13B depict an embodiment of a conductive fluid reservoir1300 that includes pressurized balloon 1304. The pressurized balloon1304 contains a conductive fluid 1302. The pressurized balloon 1304 canbe opened by puncturing the pressurized balloon 1304. The pressurizedballoon 1304 can be punctured using a puncturing device 1306, such as apin, a blade, and the like. FIG. 13A depicts the pressurized balloon1304 before being punctured by the puncturing device 1306 and FIG. 13Bdepicts the pressurized balloon 1304 after being punctured by thepuncturing device 1306 with the conductive fluid 1302 flowing out of thepressurized balloon 1304.

The puncturing device 1306 can be controlled by the wearabledefibrillator such that the pressurized balloon 1304 is puncturedautomatically before the wearable defibrillator delivers an electricaldischarge to the patient's body. The puncturing device 1306 can beoriented such that the conductive fluid 1302 is directed to increaseelectrical connectivity between an electrode of the wearabledefibrillator and the patient's skin when the pressurized balloon 1304is punctured.

Any of the pressurized balloon embodiments described herein can becontained in a rigid container in the wearable defibrillator. The rigidcontainer can prevent inadvertent rupturing of the balloon while thepatient wears the wearable defibrillator.

It should be noted that for purposes of this disclosure, the use of“including,” “comprising,” or “having” and variations thereof herein ismeant to encompass the items listed thereafter and equivalents thereofas well as additional items. Unless limited otherwise, the terms“connected” and “coupled” and variations thereof herein are used broadlyand encompass direct and indirect connections and couplings.

The principles, representative embodiments, and modes of operation ofthe present disclosure have been described in the foregoing description.However, aspects of the present disclosure which are intended to beprotected are not to be construed as limited to the particularembodiments disclosed. Further, the embodiments described herein are tobe regarded as illustrative rather than restrictive. It will beappreciated that variations and changes may be made by others, andequivalents employed, without departing from the spirit of the presentdisclosure. Accordingly, it is expressly intended that all suchvariations, changes, and equivalents fall within the spirit and scope ofthe present disclosure, as claimed.

1-20. (canceled)
 21. A system for use with a wearable defibrillator wornby a patient, the system comprising: an electrode; a source ofpressurized fluid; a container configured to contain a conductive fluid,the container having an outlet; an inflatable pouch, at least a portionof the pouch being located within the container, the pouch locatedwithin the container such that when the pouch is in a deflated state thepouch covers the outlet, the pouch in the deflated state thus preventingthe conductive fluid contained by the container from flowing out of thecontainer through the outlet; and a controller configured to controlselective delivery of the pressurized fluid from the source ofpressurized fluid to the inflatable pouch, and in which the pouch isconfigured to become inflated from the deflated state responsive to thepressurized fluid being thus delivered from the source of pressurizedfluid, and when the pouch becomes thus inflated, the pouch changes shapesuch that the pouch no longer covers the outlet and the containedconductive fluid is thus no longer prevented from thus flowing out ofthe container through the outlet near the electrode.
 22. The system ofclaim 21, in which the container is flexible or semi-rigid, and when thepouch is in the deflated state, pressing on the container causes apressure in the contained conductive fluid, the caused pressure exertedon the portion of the pouch and pushing the portion of the pouch towardthe outlet, the caused pressure thus helping prevent the containedconductive fluid from leaking out of the reservoir through the outlet.23. The system of claim 21, in which the pouch includes an inlet thatprotrudes through the container, and the pouch is configured to becomethus inflated in response to receiving the pressurized fluid through theinlet.
 24. The system of claim 21, in which the pouch has a U-shape. 25.The system of claim 21, in which the pouch has a ring shape.
 26. Thesystem of claim 21, in which as the pouch becomes thus inflated, thepouch exerts a force on the contained conductive fluid, the forcepushing the contained conductive fluid out of the container via theoutlet.
 27. The system of claim 21, in which while the pouch is in adeflated state, the pouch is sealed to the outlet that the pouch covers,and the pouch becomes no longer sealed to the outlet responsive to thepouch thus changing shape.
 28. The system of claim 27, in which thepouch is thus sealed to the outlet by an adhesive.
 29. The system ofclaim 27, in which the pouch is thus sealed to the outlet by a heatweld.
 30. The system of claim 21, in which when the pouch is in thedeflated state, the pouch is flat and has a connected end and a freeend, the free end having a saw-tooth shape that includes a valleybetween two peaks, and the outlet is located closer to the valley thanto the peaks.
 31. The system of claim 21, in which the container furtherhas an other outlet, the contained conductive fluid is initiallyprevented from flowing out of the container through the other outlet,but when the pouch becomes thus inflated, the contained conductive fluidis no longer prevented from flowing out of the container through theother outlet near the electrode.